US Codex
Bill
Notes

Title V — Program improvements for Medicare low-income beneficiaries

H.R. 3 · 116th Congress · Dec 16, 2019 · Lineage

V Program improvements for Medicare low-income beneficiaries

Sec. 501 Dissemination to Medicare part D subsidy eligible individuals of information comparing premiums of certain prescription drug plans

Section 1860D–1(c)(3) of the Social Security Act (42 U.S.C. 1395w–101(c)(3)) is amended by adding at the end the following new subparagraph:

“(C) Information on premiums for subsidy eligible individuals

“(i) In general—For plan year 2022 and each subsequent plan year, the Secretary shall disseminate to each subsidy eligible individual (as defined in section 1860D–14(a)(3)) information under this paragraph comparing premiums that would apply to such individual for prescription drug coverage under LIS benchmark plans, including, in the case of an individual enrolled in a prescription drug plan under this part, information that compares the premium that would apply if such individual were to remain enrolled in such plan to premiums that would apply if the individual were to enroll in other LIS benchmark plans.

“(ii) LIS benchmark plan—For purposes of clause (i), the term LIS benchmark plan means, with respect to an individual, a prescription drug plan under this part that is offered in the region in which the individual resides and—

“(I) that provides for a premium that is not more than the low-income benchmark premium amount (as defined in section 1860D–14(b)(2)) for such region; or

“(II) with respect to which the premium would be waived as de minimis pursuant to section 1860D–14(a)(5) for such individual.”

Sec. 502 Providing for intelligent assignment of certain subsidy eligible individuals auto-enrolled under Medicare prescription drug plans and MA–PD plans

(a)
In general— Section 1860D–1(b)(1) of the Social Security Act (42 U.S.C. 1395w–101(b)(1)) is amended—
(1)
in subparagraph (C)—
(A)
by inserting after “PDP region” the following: “or through use of an intelligent assignment process that is designed to maximize the access of such individual to necessary prescription drugs while minimizing costs to such individual and to the program under this part to the greatest extent possible. In the case the Secretary enrolls such individuals through use of an intelligent assignment process, such process shall take into account the extent to which prescription drugs necessary for the individual are covered in the case of a PDP sponsor of a prescription drug plan that uses a formulary, the use of prior authorization or other restrictions on access to coverage of such prescription drugs by such a sponsor, and the overall quality of a prescription drug plan as measured by quality ratings established by the Secretary”; and
(B)
by striking “Nothing in the previous sentence” and inserting “Nothing in this subparagraph”; and
(2)
in subparagraph (D)—
(A)
by inserting after “PDP region” the following: “or through use of an intelligent assignment process that is designed to maximize the access of such individual to necessary prescription drugs while minimizing costs to such individual and to the program under this part to the greatest extent possible. In the case the Secretary enrolls such individuals through use of an intelligent assignment process, such process shall take into account the extent to which prescription drugs necessary for the individual are covered in the case of a PDP sponsor of a prescription drug plan that uses a formulary, the use of prior authorization or other restrictions on access to coverage of such prescription drugs by such a sponsor, and the overall quality of a prescription drug plan as measured by quality ratings established by the Secretary”; and
(B)
by striking “Nothing in the previous sentence” and inserting “Nothing in this subparagraph”.
(b)
Effective date— The amendments made by subsection (a) shall apply with respect to plan years beginning with plan year 2022.

Sec. 503 Expanding eligibility for low-income subsidies under part D of the Medicare program

Section 1860D–14(a) of the Social Security Act (42 U.S.C. 1395w–114(a)), as amended by section 301(d), is further amended—
(1)
in the subsection heading, by striking “individuals” and all that follows through “line” and inserting “certain individuals”;
(2)
in paragraph (1)—
(A)
by striking the paragraph heading and inserting “Individuals with certain low incomes”; and
(B)
in the matter preceding subparagraph (A), by inserting “(or, with respect to a plan year beginning on or after January 1, 2022, 150 percent)” after “135 percent”; and
(3)
in paragraph (2)—
(A)
by striking the paragraph heading and inserting “Other low-income individuals”; and
(B)
in the matter preceding subparagraph (A), by striking “In the case of a subsidy” and inserting “With respect to a plan year beginning before January 1, 2022, in the case of a subsidy”.

Sec. 504 Automatic eligibility of certain low-income territorial residents for premium and cost-sharing subsidies under the Medicare program; Sunset of enhanced allotment program

(a)
Automatic eligibility of certain low-Income territorial residents for premium and cost-Sharing subsidies under the Medicare program—
(1)
In general— Section 1860D–14(a)(3) of the Social Security Act (42 U.S.C. 1395w–114(a)(3)) is amended—
(A)
in subparagraph (B)(v)—
(i)
in subclause (I), by striking “and” at the end;
(ii)
in subclause (II), by striking the period and inserting “; and”; and
(iii)
by inserting after subclause (II) the following new subclause:

“(III) with respect to plan years beginning on or after January 1, 2024, shall provide that any part D eligible individual who is enrolled for medical assistance under the State Medicaid plan of a territory (as defined in section 1935(f)) under title XIX (or a waiver of such a plan) shall be treated as a subsidy eligible individual described in paragraph (1).”

(B)
in subparagraph (F), by adding at the end the following new sentence: “The previous sentence shall not apply with respect to eligibility determinations for premium and cost-sharing subsidies under this section made on or after January 1, 2024.”.
(2)
Conforming amendment— Section 1860D–31(j)(2)(D) of the Social Security Act (42 U.S.C. 1395w–141(j)(2)(D)) is amended by adding at the end the following new sentence: “The previous sentence shall not apply with respect to amounts made available to a State under this paragraph on or after January 1, 2024.”.
(b)
Sunset of enhanced allotment program—
(1)
In general— Section 1935(e) of the Social Security Act (42 U.S.C. 1396u–5(e)) is amended—
(A)
in paragraph (1)(A), by inserting after “such State” the following: “before January 1, 2021”; and
(B)
in paragraph (3)—
(i)
in subparagraph (A), in the matter preceding clause (i), by inserting after “a year” the following: “(before 2024)”; and
(ii)
in subparagraph (B)(iii), by striking “a subsequent year” and inserting “each of fiscal years 2008 through 2023”.
(2)
Territory defined— Section 1935 of the Social Security Act (42 U.S.C. 1396u–5) is amended by adding at the end the following new subsection:

“(f) Territory defined—In this section, the term territory means Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.”

Sec. 505 Automatic qualification of certain Medicaid beneficiaries for premium and cost-sharing subsidies under part D of the Medicare program

Clause (v) of section 1860D–14(a)(3)(B) of the Social Security Act (42 U.S.C. 1395w–114(a)(3)(B)), as amended by section 504, is further amended—
(1)
in subclause (II), by striking “and” at the end;
(2)
in subclause (III), by striking the period and inserting “; and”; and
(3)
by inserting after subclause (III) the following new subclause:

“(IV) with respect to plan years beginning on or after January 1, 2024, shall, notwithstanding the preceding clauses of this subparagraph, provide that any part D eligible individual not described in subclause (I), (II), or (III) who is enrolled, as of the day before the date on which such individual attains the age of 65, for medical assistance under a State plan under title XIX (or a waiver of such plan) pursuant to clause (i)(VIII) or (ii)(XX) of section 1902(a)(10)(A), and who has income below 200 percent of the poverty line applicable to a family of the size involved, shall be treated as a subsidy eligible individual described in paragraph (1) for a limited period of time, as specified by the Secretary.”

Sec. 506 Providing for certain rules regarding the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost-sharing subsidies under part D of the Medicare program

Section 1860D–14(a)(3)(C)(i) of the Social Security Act (42 U.S.C. 1395w–114(a)(3)(C)(i)) is amended, by striking “except that support and maintenance furnished in kind shall not be counted as income; and” and inserting

“(I) support and maintenance furnished in kind shall not be counted as income; and

“(II) for plan years beginning on or after January 1, 2024, any distribution or withdrawal from an eligible retirement plan (as defined in subparagraph (B) of section 402(c)(8) of the Internal Revenue Code of 1986, but excluding any defined benefit plan described in clause (iv) or (v) of such subparagraph and any qualified trust (as defined in subparagraph (A) of such section) which is part of such a defined benefit plan) shall be counted as income; and”

Sec. 507 Reducing cost-sharing and other program improvements for low-income beneficiaries

(a)
Increase in income eligibility to 150 percent of FPL for qualified Medicare beneficiaries—
(1)
In general— Section 1905(p)(2)(A) of the Social Security Act (42 U.S.C. 1396d(p)(2)(A)) is amended by striking “shall be at least the percent provided under subparagraph (B) (but not more than 100 percent) of the official poverty line” and all that follows through the period at the end and inserting the following:

“(i) before January 1, 2022, at least the percent provided under subparagraph (B) (but not more than 100 percent) of the official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved; and

“(ii) on or after January 1, 2022, equal to 150 percent of the official poverty line (as so defined and revised) applicable to a family of the size involved.”

(2)
Not counting in-kind support and maintenance as income— Section 1905(p)(2)(D) of the Social Security Act (42 U.S.C. 1396d(p)(2)(D)) is amended by adding at the end the following new clause:

“(iii) In determining income under this subsection, support and maintenance furnished in kind, as described in section 1612(a)(2)(A), shall not be counted as income.”

(3)
Conforming amendments—
(A)
Section 1902(a)(10)(E) of the Social Security Act (42 U.S.C. 1396a(a)(10)(E)) is amended—
(i)
in clause (iii), by striking “for making medical” and inserting “before January 1, 2022, for making medical”; and
(ii)
in clause (iv), by striking “subject to sections” and inserting “before January 1, 2022, subject to sections”.
(B)
Section 1933 of the Social Security Act (42 U.S.C. 1396u–3) is amended—
(i)
in subsection (a), by striking “A State plan” and inserting “Subject to subsection (h), a State plan”; and
(ii)
by adding at the end the following new subsection:

“(h) Sunset—The provisions of this section shall have no force or effect after December 31, 2021.”

(b)
100 percent FMAP— Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended by adding at the end the following new subsection:

“(gg) Increased FMAP for expanded medicare cost-Sharing populations

“(1) In general—Notwithstanding subsection (b), with respect to expenditures described in paragraph (2) the Federal medical assistance percentage shall be equal to 100 percent.

“(2) Expenditures described—The expenditures described in this paragraph are expenditures made on or after January 1, 2022, for medical assistance for medicare cost-sharing provided to any individual under clause (i) or (ii) of section 1902(a)(10)(E) who would not have been eligible for medicare cost-sharing under any such clause under the income or resource eligibility standards in effect on October 1, 2018.”